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What is early miscarriage?
Miscarriage
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What is early miscarriage?
Early miscarriage is when a woman loses her pregnancy in the first three months. This may be accompanied by vaginal bleeding and pain.
Bleeding and pain in early pregnancy
Many early miscarriages occur before a woman has missed her first period or before her pregnancy has been confirmed. Once you have had a positive pregnancy test, there is around a one in five (20%) risk of having a miscarriage in the first three months. Most miscarriages occur as a 'one-off' (sporadic) event and there is a good chance of having a successful pregnancy in the future.
Why does early miscarriage occur?
Much is still unknown about why early miscarriages occur. The most common cause is chromosome problems. Chromosomes are tiny thread-like structures found in all the cells of the body. In order to grow and develop normally a baby needs a precise number of chromosomes. If there are too few or too many chromosomes, the pregnancy may end in a miscarriage.
What is the risk of having a miscarriage?
The risk of miscarriage is increased by:
- a woman's age - the risk of early miscarriage increases with age. At the age of 30, the risk of miscarriage is one in five (20%). At the age of 42, the risk of miscarriage is one in two (50%).
- health problems – as an example, poorly controlled diabetes can increase the risk of an early miscarriage.
- lifestyle factors – smoking and heavy drinking are linked with miscarriage. There is no scientific evidence to show that stress causes a miscarriage.
Early miscarriage:
Sex during pregnancy is not harmful and is not associated with early miscarriage. There is no treatment to prevent a miscarriage.
What happens if it is a miscarriage?
If the miscarriage has completed, you will not need any further treatment. If the miscarriage has not completed, there is a range of options available.
Useful Organisations
www.miscarriageassociation.org.uk
What happens if my pregnancy has failed?
There are 3 main options for a women if a pregnancy fails
- Wait for nature to resolve the situation
- Accelerate the natural process with a vaginal pessary
- Have an operation to end the bleeding
Natural option
The vast majority of miscarriages will resolve naturally is left alone. This is a safe option. The main disadvantage is that it can take some time to resolve. Many women find that this is less that a moth but a few continue bleeding a suffering uterine cramps for months. If this happens, a gynaecologist can arrange for an operation to end the bleeding the operation involves cleaning the womb.
The main risk is infection. This is rare but can be very serious if not treated very early. The main sign would be increasing tenderness, increasing bleeding, feeling unwell or a temperature. If you choose this option, you must check your temperature if you have any of these signs and consult your doctor.
Medically accelerating the natural option
Allowing nature to take care of a miscarriage is a simple and sensible option for many women. It can be made more efficient with the use of tables taken by mouth or placed in the vagina. However, these tablets probably make no difference to the final result.
Unfortunately this service is not yet available on the NHS in Avon Somerset or Wiltshire but the commissioning health care authorities (politicians responsible for funding your health care) have been asked to approve plans to provide this at the RUH.
Surgical option
Most of the following information on the surgical option has been provided by the Royal College of Obstetricians and Gynaecologists. It is relevant to women who choose surgical management of a miscarriage 2
The operation is performed to empty your uterus (womb). This is done to take away a pregnancy if it has not developed or if the pregnancy tissue has not all come away as part of a miscarriage. The technical term for your operation is a surgical evacuation of the uterus through the vagina. You should read this information along with other information about your choices and the operation itself. This information gives general advice based on women's experiences and expert opinion. Every woman has different needs and recovers in different ways. Your own recovery will depend upon:
- How fit and well you are before your operation
- Whether there are any complications
- Your way of coping with the loss of your pregnancy and your circumstances.
What can I expect after this operation?
Usual length of stay in hospital
This operation is usually done as a day case which means that you can go home on the same day. It can be done without an anaesthetic but few women choose this option
After-effects of general anaesthesia
Most modern anaesthetics are short-lasting. You should not have, or suffer from, any after-effects for more than a day after your operation. During the first 24 hours you may feel more sleepy than usual and your judgement may be impaired. If you drink any alcohol, it will affect you more than normal. You should have an adult with you during this time and should not drive or make any important decisions.
Vaginal bleeding
You can expect to have some vaginal bleeding for 1 to 2 weeks after your operation. This is like a heavy period for the first day or so. This should lessen and may become brown in colour. You should use sanitary towels rather than tampons, as using tampons could increase the risk of infection.
Discomfort
You can expect some cramps (like strong period pains) in your lower abdomen on the day of the operation.
You may get milder cramps or an ache for a day or so afterwards. When leaving hospital, you should be provided with simple painkillers to reduce any discomfort.
If you are prescribed painkillers which contain codeine or dihydrocodeine, these can make you sleepy, slightly sick and constipated.
If you do need to take these medications, try to eat extra fruit and fibre to reduce the chances of becoming constipated.
Starting to eat and drink
Once you have woken up from the anaesthetic and are not feeling too nauseous, you will be offered a drink of water or cup of tea and something light to eat. Once you are home you can eat and drink as normal.
Washing and showering
You should be able to have a shower or bath as normal after the operation. It is advisable to have someone at home with you initially so they can help you if you become dizzy or feel faint.
Formation of blood clots
There is a small risk of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis) after a miscarriage. You can reduce the risk of clots by:
- being as mobile as you can as early as you can after your operation
- doing exercises when you are resting, for example:
- pump each foot up and down briskly for 30 seconds by moving your ankle
- move each foot in a circular motion for 30 seconds
- bend and straighten your legs – one leg at a time, three times for each leg
Tiredness
You may feel very tired while your body is healing. The blood lost and the emotional distress contribute to your feeling to fartigue. Some women come to terms with what has happened within weeks; for others, it takes longer. Many women feel tearful and emotional for a short time afterwards. Some women experience intense grief over a longer time.
What can help after an operation for a miscarriage?
Your family and friends may offer support in lots of different ways. This could be in terms of practical support with things like shopping, housework or preparing meals. Most people are only too happy to help – even if it means you having to ask them. Having company gives you a chance to say how you are feeling after your miscarriage. Having company can help lift your mood as well as bring comfort. If you live alone, you may wish to have someone stay with you for the first few days after you go home.
Why might it take longer to recover?
It can take longer to recover from an operation for a miscarriage if:
- You had health problems before your operation; for example, women with diabetes may heal more slowly and may be more prone to infection
- You smoke; some women who smoke are at increased risk of getting a chest or wound infection during their recovery: smoking can delay the healing process
- You were overweight at the time of your operation; if you are overweight it can take longer to recover from the effects of anaesthesia and there can be a higher risk of complications such as infection and thrombosis
- You have had previous miscarriages
- You have taken a long time to get pregnant.
When should I seek medical advice after an operation for a miscarriage?
As with any operation, complications can occur after an operation for a miscarriage. You should seek medical advice from your GP, early pregnancy assessment unit, the hospital where you had your operation, NHS Direct or NHS 24 if you experience:
Heavy or prolonged vaginal bleeding, smelly vaginal discharge and abdominal pain:
If you also have a raised temperature (fever) and flu-like symptoms, this may be due to an infection of the lining of the uterus (womb). This occurs in two or three women in a 100 (2–3%). Treatment is with antibiotics.
Occasionally, there is still pregnancy tissue remaining in the uterus (womb) and you may need to have another surgical evacuation of the uterus
Increasing abdominal pain and you feel unwell:
If you also have a temperature (fever), have lost your appetite and are vomiting, this may be because of damage to your uterus (womb). You will be readmitted to hospital
Burning and stinging when you pass urine or pass urine frequently:
This may be caused by a urine infection. Treatment is with a course of antibiotics
A painful, red, swollen, and hot leg or difficulty bearing weight on your legs:
This may be caused by a deep vein thrombosis (DVT). If you have shortness of breath, chest pain or cough up blood, this could be a sign that a blood clot has travelled to the lungs (pulmonary embolus). If you have any of these symptoms you should contact your GP immediately who should see you on the same day
On-going sadness or depression:
Following your operation, if are not able to do the things you would normally do on a day-to-day basis, you should speak with your GP.